(P24-113-23) Associations of Health Care Expenditures With Diet, Physical Activity and Sedentarism at Population Level in Sao Paulo, Brazil (2003-2015)

Objectives: The study investigates associations of physical activity (PA), sedentary behavior (SB) and diet quality indicators with health care expenditures at population level in the municipality of Sao Paulo, Brazil.

Methods: Observational cross-sectional study with quantitative data analysis of the Sao Paulo Health Survey (ISA-Capital, N=5,307), conducted in 2003, 2008 and 2015. Health care expenditures referred to out-of-pocket health care expenses reported in the month prior to the interview. PA was assessed using International Physical Activity Questionnaire (IPAQ) long form. SB was based on self-reported minutes sitting per week. Food consumption patterns were assessed using 24-hour recalls through the revised Brazilian Healthy Eating Index (BHEI-R), referring to global diet score and its components (nine food groups, sodium, saturated fats, and calories from solid fat, alcohol and added sugar). Multivariate OLS regression models were estimated to investigate associations of PA, SB, diet quality and its components in relation to health care expenditures, including control variables for health, sociodemographic, and economic characteristics, and year of the survey. Analyses were performed in Stata 17, considering complex sample design with statistical significance p< 0.05.

Results: Health care expenditures showed negative associations with PA (b=-0.050) and BHEI-R component of cereals (β=-0.167), in addition to positive association with SB (β=0.142), controlling for individual and household characteristics. There were no statistically significant associations of health care expenditures in relation to the global diet quality represented by the BHEI-R or its other components.

Conclusions: Our findings suggest that SB and PA comprise main lifestyle factors linked to the magnitude of health care expenditures, whilst only part of diet quality indicators may be linked to out-of-pocket expenses. National health systems should target strategies focusing lifestyle changes in PA and diet quality, whilst tackling SB, towards promotion of population quality of life in the long run.

Funding Sources: São Paulo Municipal Health Department, Research Support Foundation of the State of São Paulo (FAPESP), National Council for Scientific and Technological Development (CNPq), Coordination for the Improvement of Human Resources in Higher Education (CAPES).